question

What is the broad term for *inflammation within the oral cavity*?

answer

stomatitis

question

What is one of the most common forms of stomatitis?

answer

painful ulcerations (*aphthous ulcers or "canker sores"*) that appear as inflammation or erosion of the protective lining of the mouth

question

True or False: Stomatits can affect your overall nutritional intake, therefore impacting your nutritional status

answer

true

question

What is included in *primary stomatitis*?

answer

-aphthous (noninfectious) stomatitis -herpes simplex stomatitis -traumatic ulcers

question

*Secondary stomatitis* generally results from what?

answer

-infections by opportunistic viruses, fungi, or bacteria in patients who are immunocompromised -drugs (chemotherapy)

question

How does Candida albicans cause a type of secondary stomatitis?

answer

long term ab'tic therapy destroys normal flora and Candida is allowed to overgrow, causing *candidiasis* (moniliasis) --->*a fungal infection that is very painful*)

question

Candidiasis is common in what patients?

answer

those undergoing immunosuppresive therapy, such as *chemotherapy*, *radiation*, and *steroids*

question

Stomatits can result from what?

answer

-infection -allergy -vitamin deficiency -systemic disease -irritants (tobacco and alcohol)

question

What types of foods may trigger allergic responses that cause aphthous ulcers?

answer

-coffee -potatoes -cheese -nuts -citrus fruits -gluten

question

When performing an oral assessment, what questions are important to ask?

answer

-history of recent infections -nutrition changes (*vitamin B deficiency can lead to stomatitis*) -oral hygiene habits -oral trauma -previous STDs (herpes, syphilis, etc) -stress -drug history (OTC, nutrition and herbal supplements) -if lesions interfere with swallowing, eating, or communicating -pain

question

How could ulcerations alter a patient's nutrition status?

answer

difficulty eating or swallowing may inhibit patient from receiving adequate nutrients

question

True or False: When ulcerations are severe, stomatitis and edema have potential to obstruct the airway

answer

true

question

With oral candidiasis, what appears in the oral cavity?

answer

white-plaque like lesions on the tongue, palate, pharynx, and buccal mucosa -when these patches are *wiped away*, the underlying surface is red and sore (patients may report as painful, dry, or hot)

question

When examining the oral cavity, what equipment is necessary?

answer

-gloves -penlight -tongue blade

question

What do you assess the mouth for in regards to stomatitis?

answer

-lesions -coating -cracking

question

If lesions are noticed in the oral cavity, what do you document about them?

answer

-location -size -shape -color -odor -drainage

question

What might lead you to believe that a patient would have lesions extending down into their esophagus?

answer

if you see lesions along the pharynx and if the patient reports dysphagia

question

Besides inspecting the oral cavity, what assessment is also done by the *advanced practice nurse or PCP*?

answer

palpating the cervical and submandibular lymph nodes to assess swelling

question

What is the overall goal for stomatitis?

answer

health promotion and reduced risk for infection through careful oral hygiene

question

What are some of the best practices for providing/maintaining oral care?

answer

-use soft bristled tooth brush or disposable foam swabs -use toothpaste free of sodium lauryl sulfate -teach pt to rinse mouth every 2-3 hours with sodium bicarbonate solution or warm saline solution -avoid commercial mouthwashes (high alcohol content - irritates/burns) -avoid lemon-glycerin swabs -avoid drugs that cause inflammation of mouth or reduce saliva -encourage oral hygiene/provide it after each meal or as often as needed -antibiotic therapy as ordered (*request anti-yeast meds as well*)

question

How often should you perform self-examination of your mouth?

answer

weekly (report any unusual findings ASAP)

question

How often should you floss teeth?

answer

daily (keep it out where you can see it as an encouragement to stick with routine)

question

True or False: If the patient wears dentures, he or she should keep them in even in the occurrence of stomatitis

answer

false - take them out if stomatitis or oral pain

question

If stomatitis is not controlled, how much should you increase mouth care?

answer

every 2 hours or more frequently

question

What type of food should you help patients select if they have problems with the oral cavity?

answer

soft, bland, nonacidic foods: -cool/cold liquids can be soothing -foods high in protein -foods high in vitamin C *scrambled eggs, bananas, custards, puddings, icecream* (*avoid hard, spicy, salty*)

question

True or false: Frequent, gentle mouth care promotes debridement of ulcerated lesions and can prevent superinfections

answer

true

question

True or False: Oral tumors can be benign, precancerous, or cancerous and can affect your daily functions (swallowing, chewing, speaking)

answer

true (*painful tumors can also limit daily activities and self-care*)

question

What type of oral tumor is *precancerous* and presents as slowly developing changes in the mucous membrane causing *thickened, white, firmly attached patches that CANNOT be easily scraped off*?

answer

leukoplakia

question

How does leukoplakia differ from oral candidiasis?

answer

leukoplakia CANNOT be easily scraped off, while oral candidiasis (yeast film) can be scraped off and may reveal a red underlying lesion

question

How do leukoplakia patches appear?

answer

slightly raised and sharply rounded

question

Most leukoplakia lesions are benign and can appear anywhere on the oral mucosa, but what specific location(s) are *more likely to progress to cancer*?

answer

lesions on the lips or tongue

question

What results from *mechanical factors* that cause *long-term oral mucous membrane irritation* (such as poorly fitting dentures, chronic cheek biting, or broken/poorly repaired teeth)?

answer

leukoplakia

question

What type of leukoplakia can be found in patients with HIV infection?

answer

oral hairy leukoplakia (OHL)

question

What does the Joint Co. require nurses to ask when assessing patients with oral lesions?

answer

ask about tobacco use because tobacco products (smoked, dipped, or chewed) have led to the development of leukoplakia *sometimes referred to as the "smoker's patch"*

question

What is the most common oral lesion among adults?

answer

leukoplakia

question

What is associated with Epstein-Barr virus (EBV) and can be an *early manifestation of HIV infection*?

answer

oral hairy leukoplakia (OHL)

question

When associated with HIV infection, the appearance of OHL is highly correlated with what?

answer

AIDS

question

True or False: Leukoplakia NOT associated with HIV infection is often seen in people over *40 y.o*

answer

true

question

True or False: The incidence of leukoplakia is *two times higher* in MEN than in women

answer

true (but ratio is changing because more women are smoking now)

question

What appears as *red, velvety mucosal lesions on the surface of the oral mucosa*?

answer

erythroplakia (precancerous lesions) (*can be difficult to distinguish from inflammatory or immune reactions*)

question

True or False: There are more malignant changes in erythroplakia than in leukoplakia, so erythroplakia is considered "precancerous" in presentation

answer

true (*lesions should be regard with suspicion and ANALYZED BY BIOPSY*)

question

Where is erythroplakia most commonly found?

answer

on the floor of the mouth, tongue, palate, and mandibular mucosa

question

What is one of the most effective ways of detecting oral tumors?

answer

dental exams (so make sure to express the importance of having routine dental exams)

question

How often should people visit the dentist?

answer

at least twice a year ( for dental hygiene and oral cancer screening --> inspecting and palpating the mouth of lesions)

question

What are some prevention strategies for oral cancer?

answer

-minimize sun/tanning bed exposure -stop smoking/tobacco use -decrease alcohol intake

question

True or False: Dentists use digital technology instead of x-rays because excessive, prolonged radiation from x-rays has been associated with head and neck cancer

answer

true

question

More than 90% of oral cancers are what kind?

answer

squamous cell carcinomas (begin on the surface of the epithelium)

question

What is the *earliest sign of oral carcinoma*?

answer

mucosal erythroplasia

question

Describe the oral lesions that are suspicious for cancer.

answer

-red, raises, eroded areas -a lesion that does not heal within 2 weeks -lump/thickening in the cheek

question

Who is at the highest risk for oral cancer?

answer

-people who frequently consume alcohol and use tobacco in any form -people with periodontal disease

question

What are the major risk factors in the development of oral cancer?

answer

-increasing age (most occur in 40 or older) -*tobacco use* -alcohol use -sun exposure -poor nutrition habits -poor oral hygiene -*periodontal disease* -*infection with HPV*

question

True or False: Squamous cell carcinoma can be found on the lips, tongue, buccal mucosa, and oropharynx

answer

true

question

An increased rate of squamous cell cancer is found in people with what occupations?

answer

-textile workers -plumbers -coal/metal workers *mainly due to prolonged exposure to polycyclic aromatic hydrocarbons (PAHs)*

question

If your patient's oral cancer appears in the *tonsillar area or along the base of the tongue*, what might you assume is associated with the oral cancer?

answer

HPV

question

What type of oral cancer appears *primarily on the lips*?

answer

basal cell carcinoma

question

What is the *second most common* type of oral cancer that results as a result of the *failure of basal cells to mature into keratinocytes*?

answer

basal cell

question

What is the major risk factor for basal cell carcinoma?

answer

excessive sunlight exposure

question

True or False: Basal cell carcinomas do *not* metastasize but can aggressively involve the skin of the face

answer

true (lesions are asymptomatic and resemble a scab --> may gradually evolve into a characteristic ulcer with a raised, pearly border)

question

What type of oral cancer is a *malignant lesion in blood vessels* that appears as a *raised, purple nodule or plaque* that is usually *painless*?

answer

kaposi's sarcoma

question

What is the most common site for kaposi's sarcoma?

answer

hard palate (but can also be found on the gums, tongue, or tonsils)

question

What type of oral cancer is *most often associated with AIDS*?

answer

kaposi's sarcoma

question

What are the key features (manifestations) of oral cancer?

answer

-bleeding from the mouth -poor appetite -difficulty chewing or swallowing -poor nutrition status & weight loss -thick or absent saliva -painless oral lesion that is red, raised, or eroded -thickening or lump in cheek

question

Explain the assessment for oral tumors/cancers (what questions/data to collect).

answer

-pt's routine oral hygiene -use of dentures/oral appliances -ask about oral bleeding -past/current appetite & nutrition status -difficulty chewing/swallowing -any recent weight loss -family history -use of smoking/alcohol -assess impact of oral lesions on patient's self-concept -assess any educational/cultural needs that might affect teaching or treatment -evaluate support system/past coping mechanisms

question

True or False: Stomatitis can lead to oral cancers

answer

true

question

When inspecting the mouth for oral tumors/cancer, what should you be looking for?

answer

-lesions -evidence of pain -restriction of movement -change in speech -change in voice -problems with swallowing -thick/absent saliva

question

In diagnosing oral cancers, what are the methods used?

answer

-oralCDx (brushing of a lesion to determine if precancerous) -*biopsy* (most definitive method) -CT/MRI can determine spread

question

What is the nurse's priority when caring for a patient that has extensive tumor involvement and copious, tenacious secretions?

answer

maintain open airway to promote gas exchange (removal of secretions and promotion of airway/gas exchange)

question

What are some interventions that the nurse implements to ensure patent airway and promote gas exchange?

answer

-assess for dyspnea -assess quality, rate, depth of resp. -auscultate lungs for adventitious breath sounds (*wheezes = aspiration*) (*stridor = airway obstruction*) -promote deep breathing to produce effective cough and mobilize secretions -place patient in Semi/High Fowler's -encourage fluids to liquify secretions (if able to swallow/gag) -chest physiotherapy (increases air exchange and promotes effective coughing) -oral suction (Yankauer) to remove secretions

question

True or False: Cool mist supplied by a face tent may assist with oxygen transport and the control of edema associated with oral lesions

answer

true

question

How often should you perform oral hygiene if *ulcerated lesions/infection* is present, or if in the immediate post-op period?

answer

every 2 hours

question

When might you switch your patient to an ultrasoft "chemobrush" for oral care?

answer

If the platelet count falls below *40,000* (*disposable foam brushes discouraged because they may not adequately control bacteremia-promoting plaque and may further dry the oral mucosa*)

question

True or False: Nonsurgical interventions for oral cancers includes *radiation therapy* that can be given by *external beam* or *interstitial implantation to reduce the size of the tumor before surgery*

answer

true

question

Explain the schedule for radiation therapy.

answer

treatments are typically given as *five daily treatments per week* with a *2 day break each week* over a *6-9 week period* (each treatment lasts only about 10-15 min)

question

If your patient is receiving chemotherapy as a treatment for oral cancer, what are things you need to educate your patient/family on?

answer

-side effects (give antiemetics as prescribed) -affects immune system so teach preventative measures how to avoid infection/staying away from people with infection

question

What are the responsibilities of the nurse regarding pre-op care for surgical interventions?

answer

-provide teaching to patient and family about surgery/expectations -assess/document patient understanding of disease process, rationale for surgery, and planned intervention -possible tracheostomy -loss of speech -NPO status following procedure -develop method of communication pre-op and have patient practice to avoid post-op frustration/stress

question

What are the three factors that influence the extent of the surgery performed?

answer

-size/location of tumor -tumor invasion into the bone -whether or not there has been metastasis to neck lymph nodes

question

For small, local excisions of tumors, what are the post-op restrictions?

answer

-liquid diet for a day and advance as tolerated -analgesics are prescribed -no activity limitations

question

For patients undergoing large surgical resections, what are the expectations/restrictions post-op?

answer

-temporary trache/oxygen therapy/suctioning -temporary loss of speech -frequent monitoring of VS -NPO until inrtaoral sutures are healed -IV lines in place for drug delivery and hydration -out of bed day of or first post-op day -possibility of surgical drains

question

What are the most extensive oral operations to remove tumors?

answer

-composite resections (which combine partial/total *glossectomy* and partial *mandibulectomy*)

question

What is the *commando* procedure?

answer

-COMbined neck dissection, MANDibulectomy, and Oropharyngeal resection -surgeon removes a segment of the mandible with the oral lesion and performs a radical neck dissection

question

What is the primary goal(s) of the nurse for a patient who has a temporary or permanent tracheostomy post-op?

answer

-promote airway clearance -protect surgical incision from damage and infection -pain relief -promote nutrition -ensure method of communication is available

question

What are the responsibilities of the nurse regarding *post-op care* of older adults with oral cancer?

answer

-assess mouth for candidiasis, mucositis, pain -assess for loss of appetite -assess for loss of taste -monitor weight -monitor nutrition and fluid intake -assess for difficulty eating/speaking -monitor response to medication -identify psychosocial problems *-give oral care at least every 4 hours in the early post-op phase* -*elevate HOB to prevent/reduce edema by gravity* -provide optimal *pain relief* -encourage pt. to perform swallowing exercises -teach to inspect oral cavity daily

question

How might those who have undergone surgery for oral cancer describe their pain?

answer

throbbing or pain

question

What is the initial pain medication for post-op patient who has undergone surgery for oral cancer?

answer

IV morphine with acetaminophen or ibuprofen to decrease inflammation (Tylenol or Percocet may be use for systemic relief of moderate pain after IV morphine is discontinued)

question

True or False: Patients who have undergone extensive restrictions of the oral cavity remain NPO for several days to allow healing in the oral cavity before food comes in contact with the incision

answer

true *NG or TPN* may be needed until oral nutrition can begin)

question

When oral fluid intake is started (after NPO status post-op oral surgery), what is important to asses?

answer

-signs of difficulty swallowing -aspiration -leakage of saliva or fluids from suture line -monitory daily weight and hydration status

question

What are acute complications associated with radiation?

answer

mucositis, stomatitis, alterations in taste

question

What are some long-term effects associated with radiation?

answer

-xerostomia/saliva reduction (excessive mouth dryness - causes inability to eat dry foods) -dental decay

question

True or False: Fatigue is a common side effect of both radiation and chemotherapy

answer

true

question

What kind of diet are patients whose tracheostomy tube has just been removed put on before discharge?

answer

soft diet by mouth

question

True or False: Alterations in taste and dysphagia make maintaining adequate nutrition a challenge for the oral cancer patient

answer

true

question

Why is it important to recommend *thickened* liquids to patients with dysphagia?

answer

they are easier than thin liquids (water) to control during swallowing

question

How should the chemobrush be rinsed?

answer

*after each use*: -with hydrogen peroxide and water -or with a diluted bleach solution -or with dishwater

question

How often should you change chemobrushes?

answer

weekly

question

Because skin reactions are a common side effect of radiation, what should you teach the patient?

answer

-avoid sun exposure -avoid perfumed lotions/powders -cleanse face/neck with nondeodorant soap -men use electric razor and avoid alcohol-based aftershave

question

Viscous lidocaine is prescribed for a client. What client teaching does the nurse provide? a) be certain your food's temp is not too hot b) this medication will kill bacteria found within your mouth c) you may use this drug as many times during the day as you wish d) this is the most effective medication to treat fungal infections

answer

a

question

A male client is admitted with oral cancer. Which statement by the nursing assistant indicates a need for further teaching by the nurse about this client's oral care? a) I need to do oral care at least every 2 hours b) I'll use a soft-bristled toothbrush to prevent bleeding c) I'll remind him to use mouthwash after brushing d) I'll tell him to rinse his mouth frequently with sodium bicarbonate

answer

c

question

A client has completed chemotherapy and radiation therapy for an oral tumor and is being discharged home. Which client statements require further teaching by the nurse? (SATA) a) Radiation therapy will not affect my sense of taste b) I am likely to be fatigued after radiation c) It's important for me to keep my oral cavity very clean d) I will avoid tanning beds and sun exposure e) I am eager to use my perfume soon after radiation therapy f) My chemobrush should be replaced monthly

answer

a, e, f

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